Ohio recorded 783 suicides among people 35 to 64 years old in 2010, compared with 517 in 1999. The rate increase was significantly greater than the national figure of 28 percent and higher than the increases seen in Kentucky, West Virginia and Pennsylvania. It was about even with Michigan, while Indiana had a rate increase of 53.8 percent.

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The states with the highest increases were Wyoming at 78.8 percent, North Dakota at 70.5 percent and Rhode Island at 69.1 percent, though the actual suicide numbers in those smaller states still are relatively low, between 47 and 92 in 2010.

No state experienced a decrease.

In the U.S., suicides are more common than homicides, and at more than 38,300, were the 10th-leading cause of death in the country in 2010, according to the most recent CDC data available.

Possible contributing factors to the recent uptick in suicides among the middle-aged include the economic downturn and the increasing availability of prescription drugs, according to the report.

"When I think about that age range and time period, I'm thinking of the recession and those risk factors for that age group - that's when people are going through a divorce or get forced into early retirement," Atwell said. "They lose their identity. You don't know what to do with yourself."

Atwell said the most common theme among suicides is hopelessness.

"They're so caught up in the despair of where they're at, they're not able to feel hopeful or find anything to be hopeful about," Atwell said. "It's not so much that they really want to die. They're just caught up in the pain."

Both the CDC and Atwell say that more awareness is needed, and that mental-health programs and alcohol and substance treatment need to improve, both in quality and availability.

In her 10-plus years helping people who are thinking about suicide and families who are coping with loved ones who have killed themselves, Atwell said she personally knew three people who took their lives, including a 55-year-old Cincinnati elementary school teacher who jumped to her death in 2007 from the Jeremiah Morrow Bridge near Lebanon, the tallest bridge in Ohio at 239 feet.

Atwell had worked with the principal at Summerside Elementary School to help prevent suicides among her students.

"It was just devastating. She knew how to get help," Atwell said. "People feel so hopeless they don't see a way out, and that's where a lot of people who die by suicide are at. We have to catch them long before that, know the warning signs and the risk factors."